Thyroid gland is situated in the anterior part of the neck. It can be palpable. It can be seen as a mass from outside when it is enlarged. This situation is called Goiter.
In some cases the thyroid gland grows nodules. The nodules can be detected by ultrasound investigation. Ultrasound can be done either by a radiologist or by endocrinologist. The type of the nodules can lead us to make a fine needle aspiration biopsy. This biopsy is minimally-invasive method to let us differing cellular load of the nodule. Nodules can be benign or malignant. Benign nodules are recommended to be in follow-up. Malignant cytology is referred to surgery.
Thyroid surgery can be done under general anesthesia. The surgery takes approximately 2 hours. Patient has to stay one or two nights at the hospital after the surgery. The most frightening complications of the thyroid surgery are vocal cord paralyses and hypocalemia due to resection of the parathyroid glands. Nervus laryngealis reccurrens is responsible for vocal cord movements. These nerves are located in both sides of the neck under the capsule of the thyroid gland. During the surgery the nerves are clarified and visualized and protected. Parathyroid glands are located four corners of the thyroid glands posterior surface. At least one of these four glands has to be protected during the surgery. But in some severe conditions of malignancy parathyroid glands also have to be excised.
Malignant thyroid cancers can spread to the regional structures in the neck. Lymph nodes, thyroid cartilage, trachea and strep muscles can be the metastatic areas in the neck. In this regional spread thyroidectomy is continued with neck dissection in the same operation.
Neuron Integrity Monitor can be used to monitor the nervus layrngealis reccurrens to protect the vocal cords’ movements.
After the surgery the patients should be followed by an Endocrinologist. If pathology reveals tumor diagnosis as Papillary Thyroid Carcinoma patient might need to take radioactive Iodine treatment after the surgery. During the follow-up for the controls sometimes patient will be asked to go for Thyroid Scintigraphy with 5mEq Radioactive Iodine.
Assoc. Prof. Dr. Mete İnançlı is a Head and Neck surgeon who is performing thyroidectomy and neck dissections during his operating room practice in Cyprus.